Provider Demographics
NPI:1578965711
Name:SHARROTT, KATHLEEN (CNM)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:
Last Name:SHARROTT
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:STONY BROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11790-0988
Mailing Address - Country:US
Mailing Address - Phone:631-444-4686
Mailing Address - Fax:631-444-4622
Practice Address - Street 1:6 TECHNOLOGY DRIVE
Practice Address - Street 2:
Practice Address - City:EAST SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-8091
Practice Address - Country:US
Practice Address - Phone:631-444-4686
Practice Address - Fax:631-444-4622
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF001639367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife